Tang Jin, Wang Kaimeng, Xu Haoming, Han Jingzhe
Department of General Practice, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, China.
Department of Neurology, Hebei General Hospital, Shijiazhuang, China.
Front Cell Infect Microbiol. 2024 Dec 24;14:1509630. doi: 10.3389/fcimb.2024.1509630. eCollection 2024.
Varicella zoster virus-related encephalitis (VZV-RE) is a rare and often misdiagnosed condition caused by an infection with the VZV. It leads to meningitis or encephalitis, with patients frequently experiencing poor prognosis. In this study, we used metagenomic next-generation sequencing (mNGS) to rapidly and accurately detect and identify the VZV pathogen directly from cerebrospinal fluid (CSF) samples, aiming to achieve a definitive diagnosis for encephalitis patients.
In this retrospective study, we analyzed the clinical characteristics and laboratory evaluations of 28 patients at the Harrison International Peace Hospital in Hebei, China, between 2018 and 2024. These patients were diagnosed with neurological disorders using mNGS techniques applied to CSF.
In this cohort of 28 patients, 11 were females and 17 males, with a median age of 65 (IQR: 42.3-70). VZV-RE presented with a range of clinical manifestations, the most common being headaches (81.2%), fever>38°C (42.9%), and vomiting (42.9%). Less frequent symptoms include personality changes (10.7%), speech impairments (21.4%), cranial nerve involvement (21.4%), altered consciousness (17.9%) and convulsions (3.6%). Herpes zoster rash was observed in 35.7% of the cases. Neurological examination revealed nuchal rigidity in only 5 patients. CSF analysis indicated mild pressure and protein levels increase, with all patients having negative bacterial cultures. Abnormal electroencephalogram (EEG) findings were noted in 10.7% (N=3), and encephalorrhagia on Magnetic Resonance Imaging (MRI) was observed in 3.6%. VZV-RE was confirmed through mNGS analysis of CSF within three days of admission. All patients received empiric treatment with acyclovir or valacyclovir, with 21.4% receiving hormonotherapy, and 7.14% receiving immunoglobulin therapy. At the three-month follow-up, 10.7% of the patients had persistent neurologic sequelae, and the mortality rate was 3.6%.
Performing mNGS on CSF offers a rapidly and precisely diagnostic method for identifying causative pathogens in patients with VZV central nervous system (CNS) infections, especially when traditional CNS examination results are negative. Furthermore, the cases reported highlight the positive therapeutic effect of ganciclovir in treating VZV infections.
水痘带状疱疹病毒相关性脑炎（VZV-RE）是由水痘带状疱疹病毒（VZV）感染引起的一种罕见且常被误诊的疾病。它会导致脑膜炎或脑炎，患者预后通常较差。在本研究中，我们使用宏基因组下一代测序（mNGS）技术直接从脑脊液（CSF）样本中快速、准确地检测和鉴定VZV病原体，旨在对脑炎患者做出明确诊断。
在这项回顾性研究中，我们分析了2018年至2024年期间在中国河北哈里森国际和平医院的28例患者的临床特征和实验室检查结果。这些患者通过应用于脑脊液的mNGS技术被诊断为神经系统疾病。
在这28例患者中，女性11例，男性17例，中位年龄为65岁（四分位间距：42.3 - 70）。VZV-RE表现出一系列临床表现，最常见的是头痛（81.2%）、发热>38°C（42.9%）和呕吐（42.9%）。较少见的症状包括人格改变（10.7%）、言语障碍（21.4%）、脑神经受累（21.4%）、意识改变（17.9%）和抽搐（3.6%）。35.7%的病例观察到带状疱疹皮疹。神经系统检查仅在5例患者中发现颈项强直。脑脊液分析显示压力轻度升高和蛋白水平升高，所有患者细菌培养均为阴性。10.7%（N = 3）的患者脑电图（EEG）结果异常，3.6%的患者磁共振成像（MRI）显示有脑出血。入院三天内通过脑脊液的mNGS分析确诊为VZV-RE。所有患者均接受了阿昔洛韦或伐昔洛韦的经验性治疗，21.4%的患者接受了激素治疗，7.14%的患者接受了免疫球蛋白治疗。在三个月的随访中，10.7%的患者有持续性神经后遗症，死亡率为3.6%。
对脑脊液进行mNGS为鉴定VZV中枢神经系统（CNS）感染患者的致病病原体提供了一种快速、精确的诊断方法，特别是当传统的CNS检查结果为阴性时。此外，报告的病例突出了更昔洛韦在治疗VZV感染方面的积极治疗效果。
